Health care in and outside a DMP for type 2 diabetes mellitus in Germany: results of an insurance customer survey focussing on differences in general education status

Aim: The Disease Management Programmes (DMPs) introduced in Germany since 2003 are intended to improve health care for the chronically ill. Whether they do this is currently being investigated in various evaluation settings. In order to assess possible changes in the process quality from the point of view of patients, the BARMER health insurance company conducted a national postal survey in Germany in 2007 of its customers with diabetes mellitus type 2 in order to compare programme participants and non-participants. This evaluation is a sub-analysis intended to clarify whether the utilisation, acceptability and perceived benefits of the programme differ as a result of educational status. Subjects and Methods: A nationally representative random sample was drawn from BARMER insurance customers with type 2 diabetes, aged 45–79 years. Questionnaires were evaluated from 38.5% of the sample (DMP-participant respondents: n = 2,158; non-participant respondents: n = 2,182). Results: A lower educational status was related among other things with increased morbidity, a poorer level of information and also a less well-developed “preventive attitude” to the disease. The finding that 49% of participants had a higher school qualification compared with 45% of non-participants, although significant, is less pronounced than the differences found between DMP participants and non-participants for other values analysed. A social influence could be found concerning the differences in treatment provided within the programme. A multivariate analysis shows that both the participation in the programme and higher levels of education have independent positive effects on the satisfaction with health status, with the effect of programme participation being stronger. Conclusions: It can be assumed that the clear differences established between the groups of DMP participants and non-participants can in no way be explained solely by the comparatively small difference related to school education. Patients obviously appreciate the fact that the health personnel and the insurance company are paying increased interest to their disease, and this is true to an increased degree for participants with only basic schooling. Although overall this group is significantly under-represented among the participants, they reported to an increased degree that they were profiting from the programme

Global reorganization of the nuclear landscape in senescent cells.

Cellular senescence has been implicated in tumor suppression, development, and aging and is accompanied by large-scale chromatin rearrangements, forming senescence-associated heterochromatic foci (SAHF). However, how the chromatin is reorganized during SAHF formation is poorly understood. Furthermore, heterochromatin formation in senescence appears to contrast with loss of heterochromatin in Hutchinson-Gilford progeria. We mapped architectural changes in genome organization in cellular senescence using Hi-C. Unexpectedly, we find a dramatic sequence- and lamin-dependent loss of local interactions in heterochromatin. This change in local connectivity resolves the paradox of opposing chromatin changes in senescence and progeria. In addition, we observe a senescence-specific spatial clustering of heterochromatic regions, suggesting a unique second step required for SAHF formation. Comparison of embryonic stem cells (ESCs), somatic cells, and senescent cells shows a unidirectional loss in local chromatin connectivity, suggesting that senescence is an endpoint of the continuous nuclear remodelling process during differentiation

Hematological Changes in Women and Infants Exposed to an AZT-Containing Regimen for Prevention of Mother-to-child-transmission of HIV in Tanzania.

Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend an antiretroviral combination regimen involving zidovudine (AZT) during pregnancy, single-dosed nevirapine at labor onset, AZT plus Lamivudine (3TC) during delivery, and AZT/3TC for 1-4 weeks postpartum. As drug toxicities are a relevant concern, we assessed hematological alterations in AZT-exposed women and their infants. A cohort of HIV-positive women, either with AZT intake (n = 82, group 1) or without AZT intake (n = 62, group 2) for PMTCT during pregnancy, was established at Kyela District Hospital, Tanzania. The cohort also included the infants of group 1 with an in-utero AZT exposure ≥4 weeks, receiving AZT for 1 week postpartum (n = 41), and infants of group 2 without in-utero AZT exposure, receiving a prolonged 4-week AZT tail (n = 58). Complete blood counts were evaluated during pregnancy, birth, weeks 4-6 and 12. For women of group 1 with antenatal AZT intake, we found a statistically significant decrease in hemoglobin level, red blood cells, white blood cells, granulocytes, as well as an increase in red cell distribution width and platelet count. At delivery, the median red blood cell count was significantly lower and the median platelet count was significantly higher in women of group 1 compared to group 2. At birth, infants from group 1 showed a lower median hemoglobin level and granulocyte count and a higher frequency of anemia and granulocytopenia. At 4-6 weeks postpartum, the mean neutrophil granulocyte count was significantly lower and neutropenia was significantly more frequent in infants of group 2. AZT exposure during pregnancy as well as after birth resulted in significant hematological alterations for women and their newborns, although these changes were mostly mild and transient in nature. Research involving larger cohorts is needed to further analyze the impact of AZT-containing regimens on maternal and infant health

SC3: consensus clustering of single-cell RNA-seq data

Single-cell RNA-seq enables the quantitative characterization of cell types based on global transcriptome profiles. We present single-cell consensus clustering (SC3), a user-friendly tool for unsupervised clustering, which achieves high accuracy and robustness by combining multiple clustering solutions through a consensus approach (http://bioconductor.org/packages/SC3). We demonstrate that SC3 is capable of identifying subclones from the transcriptomes of neoplastic cells collected from patients.V.Y.K., T.A., A.Y. and M.H. are supported by Wellcome Trust Grants. K.N.N. is supported by the Wellcome Trust Strategic Award 'Single cell genomics of mouse gastrulation'. M.T.S. acknowledges support from FRS-FNRS; the Belgian Network DYSCO (Dynamical Systems, Control and Optimisation), funded by the Interuniversity Attraction Poles Programme initiated by the Belgian State Science Policy Office; and the ARC (Action de Recherche Concerte) on Mining and Optimization of Big Data Models, funded by the Wallonia-Brussels Federation. M.B. acknowledges support from EPSRC (grant EP/N014529/1). T.C. was funded through a core funded fellowship by the Sanger Institute and a Chancellor′s fellowship from the University of Edinburgh. K.K. and A.R.G. are supported by Bloodwise (grant ref. 13003), the Wellcome Trust (grant ref. 104710/Z/14/Z), the Medical Research Council, the Kay Kendall Leukaemia Fund, the Cambridge NIHR Biomedical Research Center, the Cambridge Experimental Cancer Medicine Centre, the Leukemia and Lymphoma Society of America (grant ref. 07037) and a core support grant from the Wellcome Trust and MRC to the Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute. W.R. was supported by BBSRC (grant ref. BB/K010867/1), the Wellcome Trust (grant ref. 095645/Z/11/Z), EU BLUEPRINT and EpiGeneSys

Mutations in Subunits of the Activating Signal Cointegrator 1 Complex Are Associated with Prenatal Spinal Muscular Atrophy and Congenital Bone Fractures

Transcriptional signal cointegrators associate with transcription factors or nuclear receptors and coregulate tissue-specific gene transcription. We report on recessive loss-of-function mutations in two genes (TRIP4 and ASCC1) that encode subunits of the nuclear activating signal cointegrator 1 (ASC-1) complex. We used autozygosity mapping and whole-exome sequencing to search for pathogenic mutations in four families. Affected individuals presented with prenatal-onset spinal muscular atrophy (SMA), multiple congenital contractures (arthrogryposis multiplex congenita), respiratory distress, and congenital bone fractures. We identified homozygous and compound-heterozygous nonsense and frameshift TRIP4 and ASCC1 mutations that led to a truncation or the entire absence of the respective proteins and cosegregated with the disease phenotype. Trip4 and Ascc1 have identical expression patterns in 17.5-day-old mouse embryos with high expression levels in the spinal cord, brain, paraspinal ganglia, thyroid, and submandibular glands. Antisense morpholino-mediated knockdown of either trip4 or ascc1 in zebrafish disrupted the highly patterned and coordinated process of α-motoneuron outgrowth and formation of myotomes and neuromuscular junctions and led to a swimming defect in the larvae. Immunoprecipitation of the ASC-1 complex consistently copurified cysteine and glycine rich protein 1 (CSRP1), a transcriptional cofactor, which is known to be involved in spinal cord regeneration upon injury in adult zebrafish. ASCC1 mutant fibroblasts downregulated genes associated with neurogenesis, neuronal migration, and pathfinding (SERPINF1, DAB1, SEMA3D, SEMA3A), as well as with bone development (TNFRSF11B, RASSF2, STC1). Our findings indicate that the dysfunction of a transcriptional coactivator complex can result in a clinical syndrome affecting the neuromuscular system

Modelling the effects of environmental heterogeneity within the lung on the tuberculosis life-cycle

Funding: This work was supported by the Medical Research Council [grant number MR/P014704/1] and the PreDiCT-TB consortium (IMI Joint undertaking grant agreement number 115337, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EF-PIA companies’ in kind contribution.Progress in shortening the duration of tuberculosis (TB) treatment is hampered by the lack of a predictive model that accurately reflects the diverse environment within the lung. This is important as TB has been shown to produce distinct localisations to different areas of the lung during different disease stages, with the environmental heterogeneity within the lung of factors such as air ventilation, blood perfusion and oxygen tension believed to contribute to the apical localisation witnessed during the post-primary form of the disease. Building upon our previous model of environmental lung heterogeneity, we present a networked metapopulation model that simulates TB across the whole lung, incorporating these notions of environmental heterogeneity across the whole TB life-cycle to show how different stages of the disease are influenced by different environmental and immunological factors. The alveolar tissue in the lung is divided into distinct patches, with each patch representing a portion of the total tissue and containing environmental attributes that reflect the internal conditions at that location. We include populations of bacteria and immune cells in various states, and events are included which determine how the members of the model interact with each other and the environment. By allowing some of these events to be dependent on environmental attributes, we create a set of heterogeneous dynamics, whereby the location of the tissue within the lung determines the disease pathological events that occur there. Our results show that the environmental heterogeneity within the lung is a plausible driving force behind the apical localisation during post-primary disease. After initial infection, bacterial levels will grow in the initial infection location at the base of the lung until an adaptive immune response is initiated. During this period, bacteria are able to disseminate and create new lesions throughout the lung. During the latent stage, the lesions that are situated towards the apex are the largest in size, and once a post-primary immune-suppressing event occurs, it is the uppermost lesions that reach the highest levels of bacterial proliferation. Our sensitivity analysis also shows that it is the differential in blood perfusion, causing reduced immune activity towards the apex, which has the biggest influence of disease outputs.Publisher PDFPeer reviewe

Origin of the low-mass electron pair excess in light nucleus-nucleus collisions

We report measurements of electron pair production in elementary p+p and d+p reactions at 1.25 GeV/u with the HADES spectrometer. For the first time, the electron pairs were reconstructed for n+p reactions by detecting the proton spectator from the deuteron breakup. We find that the yield of electron pairs with invariant mass Me+e- > 0.15 GeV/c2 is about an order of magnitude larger in n+p reactions as compared to p+p. A comparison to model calculations demonstrates that the production mechanism is not sufficiently described yet. The electron pair spectra measured in C+C reactions are compatible with a superposition of elementary n+p and p+p collisions, leaving little room for additional electron pair sources in such light collision systems.Comment: 11 pages, 2 figures, \usepackage{epsfig

Optimización del tratamiento farmacológico en pacientes con disfunción sistólica severa del ventrículo izquierdo en una unidad de insuficiencia cardiaca: implicaciones en la indicación de un desfibrilador automático implantable en prevención primaria y factores predictores de ausencia de remodelado reverso del ventrículo izquierdo

Distance education is going through a paradigm shift from the second to the third generation. In the first generation (correspondence education) teachers were craftsmen who coupled traditional learning materials to self-made personalised lessons that they mailed to their students at a distance. In the second generation new, pedagogically enhanced materials were designed and developed via an industrial model specifically for distance education, but the accent remained on a traditional learning paradigm. In the third generation personal, competence based, interactive materials for learning communities are being designed and developed. This chapter first outlines the haracteristics of the first two generations. It then presents a framework for the design, development and delivery of distance education study materials according to the industrial approach. It concludes with a look at how this will change as we go to the third generation. In another chapter (Valcke, Kirschner & Bos) an environment for this new paradigm is worked out